Provider Demographics
NPI:1043854979
Name:FREDERICK, GREGORY L (RCSWI)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:L
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3918
Mailing Address - Country:US
Mailing Address - Phone:561-444-3512
Mailing Address - Fax:800-915-6119
Practice Address - Street 1:5975 SUNSET DR STE 504
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5118
Practice Address - Country:US
Practice Address - Phone:561-444-3512
Practice Address - Fax:800-915-6119
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor